• 한국의료질향상학회지
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• 제5권2호
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• pp.258-276
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• 1998

This study was conducted to justify the "prescribed shelf life" currently used in Samsung Medical Center and give recommendations based on scientific data to adopt for safe and cost-effective storage times for sterile goods Since the early 1970's, predetermined expiration dating policy has been used in Korea on all in-house sterilized products like any other countries; six months for the supplies wrapped in polyethylene peel pouches and two weeks for the rest. Recently, however, the studies suggest that current standards for preserving the sterility can be changing. It looks like we unnecessarily have too-short expiration date of sterilized supplies, that is far from being cost effective. Certainly, this research is an exciting project, especially in Korea, and will be leading and contributing to the paradigm shift of the conservative concept of shelf life for sterile supplies in Korean healthcare facilities. The major goal of this study was placed on the measurement of the recontamination time in packs wrapped in all kinds of wrapping materials used in S.M.C and stored in various conditions for periods ranging from three months to six months, and then develop a practical standard of "shelf life" based on the analyzed data. Objectives: To measure and compare the recontamination time of sterile packs among wrapppers and storage conditions, and develop a practical standard for the shelf life and storage conditions of sterile products. Samples and Method: The sterile integrity was investigated of the total 1,440 sterile sample packs containing gauze strip($1.5cm{\times}0.5cm$) we prepared and wrapped in nine wrapping materials (randomized reprocessed linens, linens reprocessed 99 times, linens reprocessed 120 times, new kraft paper, used kraft paper, new nonwoven fabrics, 6-time reprocessed nonwoven fabrics, new polyethylene peel pouches, used polyethylene peel pouches), and stored in four locations(closed cabinet of one of the typical wards, open shelf of one of ICUs, open shelf of separate storage room in ER, open shelf in OR), for three to six months, respectively in 1998. Each type of packs were opened weekly and the gauze strips inoculated into Brewer's thioglycollate broth at $35^{\circ}C$ for seven days. Results: There was no growth found for any types of the pack and storage conditions studied. Discussion: This study was conducted in an attempt to identify the possibility of extending the current shelf life for sterile goods we use in a sense of cost effectiveness. The findings suggest that we could extend our expiration dates, that means we can save a lot of materials and personnel time meeded for resterilizing, outdating, recleaning, wrapping, and reshelving. Then it will initiate a great reform in the field of healthcare in Korea, and now we are looking forward to this valuable revolution. We are going to continue this study and take all steps need to apply this new concept to our practice, and then trying to extend to other hospitals.

• 한국병원경영학회지
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• 제21권4호
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• pp.1-12
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• 2016

The purpose of this study are suggest to performance measurement model of Electronic Medical Record(EMR) and Key Performance Index(KPI). For data collection, 665 questionnaires were distributed to medical record administrators and insurance reviewers at 31 hospitals, and 580 questionnaires were collected(collection rate: 87.2%). Regarding methodology, Critical Success Factor(CSF) and index of the information system were derived based on previous studies, and these were set as performance measurement factors of EMR system. The performance measurement factors were constructed by perspective using BSC, and analysis on causal relationship between factors was conducted. A model of causal relationship was established, and performance measurement model of EMR system was proposed through model validation. Analysis on causal relationship between performance management factors revealed that utility cognition of the learning & growth perspective factor had causal relationship with job efficiency(${\beta}=0.20$) and decision support(${\beta}=0.66$) of the internal process perspective factors, and security had causal relationship with system satisfaction(${\beta}=0.31$) of the customer perspective factor. System quality had causal relationship with job efficiency(${\beta}=0.66$) and decision support(${\beta}=0.76$) of the internal process perspective factors, all of which were statistically significant(P<0.01). Job efficiency of the internal process perspective had causal relationship with system satisfaction(${\beta}=0.43$), and decision support had causal relationship with decision support satisfaction(${\beta}=0.91$) and job satisfaction (${\beta}=0.74$), all of which were statistically significant(P<0.01). System satisfaction of the customer perspective had causal relationship with job satisfaction(${\beta}=0.12$), job satisfaction had causal relationship with cost reduction(${\beta}=0.53$) of the financial perspective, and decision support satisfaction had causal relationship with productivity improvement(${\beta}=0.40$)of the financial perspective(P<0.01). Also, cost reduction of the financial perspective had causal relationship with productivity improvement(${\beta}=0.37$), all which were statistically significant(P<0.05). Suitability index verification of the performance measurement model whose causal relationship was found to be statistically significant revealed that $X^2/df=2.875$, RMR=0.036, GFI=0.831, AGFI=0.810, CFI=0.887, NFI=0.838, IFI=0.888, RMSEA=0.057, PNFI=0.781, and PCFI=0.827, all of which were in suitable levels. In conclusion, the performance measurement indices of EMR system include utility cognition, security, and system quality of the learning & growth perspective, decision support and job efficiency of the internal process perspective, system satisfaction, decision support satisfaction, and job satisfaction of the customer perspective, and productivity improvement and cost reduction of the financial perspective. In this study, it is expected that the performance measurement indices and model of EMR system which are suggested by the author, will be a measurement tool available for system performance measurement of EMR system in medical institutions.

• 보건행정학회지
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• 제30권1호
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• pp.131-138
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• 2020

The purpose of this study was to compare the health status of South Korea with those of Organization for Economic Cooperation and Development (OECD) countries and examine the trends. Position vAlue for Relative Comparison (PARC) was used as a gauge for comparison, and five sectors of the health care system were measured: demand, supply, accessibility, quality, and cost. The Mann-Kendall test was used as a statistical analysis method to examine trend of PARC values obtained from 2000 to recent years. According to the results, the demand, supply, accessibility, and quality sectors were higher than the OECD average, while the cost was lower than the average. However, there is a recent trend of sharp increases in health care costs. Some indicators: health employment, quality of primary care and mental health care were lower than the OECD average, and health determinants showed a worsening trend. Therefore, policy-makers need to take this into account and make efforts for sustainable health care.

• 보건의료산업학회지
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• 제6권4호
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• pp.143-152
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• 2012

This study analyzes Korea health panel data (2008) (beta version 1.2) of Korea Institute for Health and Social Affairs, and National Health Insurance Corporation to figure out determinants of healthcare expenditure. In result of Multiple Logistic Analysis, in-patents felt burden on the medical expenditure were 70.0%. As to the patients' payment of medical expenditure, patients over 65 years old had 4.765 times higher than those under 14 years, disabled patients 2.778 than non-disabled patients, chronic patients 1.632 times than non-chronic patients, patients belonging to 12 million won ~ 46 million won and under 12 million won in family income had 1.680 times and 2.168 times respectively than patients with over 46 million won, patients in professional recuperation facility 1.546 times than patients in hospital, patients in private medical institutions 1.700 times than patients in national and public medical institutions, patients using upper grade rooms 1.701 times than patients in non-upper grade rooms. As a health care safety net mechanism to protect people from medical expenditure burden, there is the patients' payment ceiling in the National Health Insurance System. Thus, in order to facilitate the patient's payment ceiling, it is required that the level of ceiling is to be specified according to the income level, and self-payment items is to be included.

• BioChip Journal
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• 제12권4호
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• pp.326-331
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• 2018

Contamination by pesticides is an everincreasing problem associated with fields of environmental management and healthcare. Accordingly, appropriate treatments are in demand. Pesticide detection methods have been researched extensively, aimed at making the detection convenient, fast, cost-effective, and easy to use. Among the various detecting strategies, paper-based assay is potent for real-time pesticide sensing due to its unique advantages including disposability, light weight, and low cost. In this study, a paper-based sensor for chlorpyrifos, an organophosphate pesticide, has been developed by layering three sheets of patterned plates. In colorimetric quantification of pesticides, the blue color produced by the interaction between acetylcholinesterase and indoxyl acetate is inhibited by the pesticide molecules present in the sample solutions. With the optimized paper-based sensor, the pesticide is sensitively detected (limit of detection =8.60 ppm) within 5min. Furthermore, the shelf life of the device is enhanced to 14 days after from the fabrication, by treating trehalose solution onto the deposited reagents. We expect the paper-based device to be utilized as a first-screening analytic device for water quality monitoring and food analysis.

• 한국의료질향상학회지
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• 제5권2호
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• pp.324-334
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• 1998

Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

• 한국병원경영학회지
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• 제20권3호
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• pp.45-55
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• 2015

While the influence of healthcare accreditation system to the quality improvement of hospitals has more increased, regarding the preparation costs for healthcare accreditation, it has never been empirically studied about the costs that are actually invested by hospitals. This study is going to determine the difficulties in the preparation process of accreditation and details of accreditation preparation costs for hospitals that participated in the healthcare accreditation system and acquired accreditation. The survey was performed in a self-reported form from February 28 to March 21 2014 for 189 acute hospitals accredited as a hospital from 2011 to February 2014. Of all questionaries of survey participants, 98 were recovered; the response rate was 51.9%. A total of 40 questionnaires were used except for 58 containing insincere answers. Main findings are followings: Firstly, findings showed that advanced general hospitals spent the most statistically significantly highest in terms of equipments and total costs among cost items for accreditation preparation. When accreditation preparation costs items were classified according to classification of hospitals, advanced general hospitals spent the most statistically significantly highest in the equipments and total costs. Also in terms of regional, Gyeonggi, Incheon regions were found to spend statistically significantly higher costs in the equipments costs. Secondly, as a result of the survey in the distribution of the total accreditation preparation costs, advanced general hospitals have disbursed the most out of all. However, the result in hospitals does not show significant difference to the expense of advanced general hospitals and that especially other regional hospitals spent higher costs. As such, all hospitals are under a heavy burden of higher costs on accreditation preparation, especially hospitals. The build-up of infrastructures by hospitals through an accreditation system consequently led to a higher initial investment; if the accreditation system is effective in improving the quality of health care and patient safety, appropriate responses are needed. In other words, financial support for investment costs needs to be given to allow hospitals to actively participate in the accreditation system.

• 보건행정학회지
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• 제22권1호
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• pp.29-48
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• 2012

The purpose of this study is to analyze medical expenses by decedents in their last year of life and compare them with those by survivors during the year 2008. This study is conducted firstly in Korea, except some studies focusing on medical cost of decedents from specific diseases. To study this, national health insurance(NHI) claims data was used with medicaid claims data. The study group(decedents) was selected from the insurance entitlement file who were dropped out from January to December of 2008. The control group(survivors) was selected from the entitlement file by stratified sampling with keeping age-sex composition of the study group. The medical expenses of decedents during one year before death were measured and compared with those of survivors by sex and age. And the medical expenses were analyzed by causes of death, and also the expenses were examined by each item of medical services. On average, the medical expense amounted to 11 million Korean Won per decedent during their last year of life in 2008. The medical expense per decedent was 9.3 higher than that of survivor. The death-related expense of under the age 35 was about 16 million Won, compared with 4 million Won in the case of over the age 95, in average. The death-related expense is higher in younger ages. This means that more medical resources are put in to save life in younger ages. Total death-related expenditure took 8.3 percent in total NHI expenditures. Of the death-related medical expenses, the largest one was injection-related cost which shares twenty five percent, and the second largest one was hospitalization charges, and then the third one was surgery cost. The results of this study suggested that we should pay attention to the medical expenses in the last of year of life when we study health care expenditure in Korea. In addition, we have to deliberate health care policy to cope with medical expenditures before death in more efficient way.

• 보건행정학회지
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• 제11권2호
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• 대한안과학회지
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• 제59권11호
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• pp.1039-1048
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• 2018

목적: 연령관련황반변성 환자에 대해 항혈관내피성장인자의 가능한 치료 방법에 따라 건강보험 재정에 미치는 영향을 분석하였다. 대상과 방법: 여러 치료 방법에 따른 건강보험 재정의 변화를 향후 5년(2018-2022년) 동안 추정하였다. 새로운 급여기준 이외 바이오시밀러 등장, 허가초과 비급여약제 사용 등을 고려한 시나리오에 대해서도 재정 영향을 분석하였다. 국민건강보험공단 청구자료 및 의료기관 자료를 기준으로 각 시나리오별로 향후 5년 동안 예상 진료환자 수, 치료 횟수를 추정하였으며, 재정부담을 추계하였다. 결과: 연령관련황반변성에서 현행의 사용형태로 기존 급여기준(평생 14회)이 유지되는 경우(시나리오 1) 2018년 기준 향후 5년간 보험소요재정은 약 4,403억 원으로 추정되었다. 2017년 12월에 변경된 급여기준하에서 5년간 보험소요재정은 약 5,601억 원으로 추정되었다. 2020년 이후 바이오시밀러 급여(시나리오 3), 현재 허가초과 비급여약제인 베바시주맙(시나리오 4)을 급여전환하는 경우에 각각 5,210억 원, 4,197억 원으로 예상되었다. 결론: 본 평생 14회라는 급여기준 삭제로 인해 건강보험 재정이 크게 증가할 것이 예상되었으나 실제 0.1 이하 그리고 반흔화/위축성 병변일 경우 급여 중단 등의 새로운 기준으로 중간폭으로 증가하는 것으로 나타났다. 또한 고령화로 인한 연령관련황반변성 유병환자의 증가를 고려할 때 바이오시밀러 및 베바시주맙 도입 등의 정책적 대안도 고려할 수 있다.